| NPI | 1134424849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2472E0500X Technician, Other, EEG |
| Additional Taxonomies | 246ZE0500X Specialist/Technologist, Other, EEG |
| 101YP1600X Counselor, Pastoral | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-01-12 |
| Last Update Date | 2013-12-12 |